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<br /> "pol,„ ELECTRICAL PERMIT APPLICATION
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<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 1- 3200 CEDAR STREET, EVERETT, WA 98201
<br /> (P)425•-257-8810 ( FAX 425-257.8857 (E)everetteps@everettwa.gov[ www.everettwa.gov/permits
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<br /> PROJECT ADDRESS: '4/0-2`r / / C eeil/R/1? 3 JO
<br /> BUILDING AREA(if residential,new constructio ,remodel,or addition) SF
<br /> BUILDING TYPE: D SFR-DETACHED 0 SFR-ATTACHED
<br /> 0 DUPLEX D MULTI-FAMILY-#OF UMTS: COMMERCIAL
<br /> USE OF BUILDING: O T fl4 ' EYGjr. t
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<br /> CONTRACT PRICE OF WORK:$ r/91000
<br /> NUMBER OF DEVICES(if low voltage):
<br /> FIRE ALARM? D YES $j NO
<br /> ASSOCIATED BUILDING PERMIT##(if
<br /> /applic�able)): y-
<br /> DESCRIPTION OF WORK: Gv/LC7:c.-1 title CfL / / ,I /t, 5� G /
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<br /> 1 ._t. _.. .. [:tOM'TACT:INFORMATIOM: ..
<br /> OWNER NAME: TENANT NAME(If Commercial); //J('
<br /> OWNER MAILING ADDRESS: STREET pa &Z( 3707
<br /> cm' .50 t7'LE STATE 1^/, 519 /2L 2267
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: . (}� ,i 5 eue-ria0
<br /> CONTRACTOR ADDRESS: sTRREer Po Box 440
<br /> CRY /nag/14EZ.3 STATEVit ZIP e9g2421
<br /> CONTRACTOR PHONE:42 -294-4944 CONTRACTOR EMAIL: kA-iei. H4/11mE1 kii'wir. COM
<br /> CONTRACTOR LIC.#(REQUIRED)( EN8gC.� . �DZ CITY OF EVERETT IAUSINESS LIC.#(REQUIRED):0405e/
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<br /> PRIMARY CONTACT: D OWNER EI CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: � CONTACT PHONE: Zt -736-4546,
<br /> . +) N1`t 15 e_eout) CONTACT EMAIL: DEN i,„ozoki Y klEUI/11 T. &0M
<br /> AGREEMENT:T hereby cerlify that I have read and examined this application and know the same to be true and correct Aliprovisions of laws and ordinances governing this
<br /> type of work will be completed whether specified herein or not The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or
<br /> local law regulating construction or the performance of construction, That!am authorized by the owner of this property to perform the work for which application is made and I
<br /> comply with the State Contractors Law 18.27 RCW and 296.20d WAC.
<br /> City of Everett Official Use Only
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<br /> PERMIT#
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<br /> Owner/Au or zed Agen Signature Date (Revised 10112/2015)
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